Should People Who Refuse Vaccines Pay A Price?

NEAL CONAN, host: In New Zealand, a sudden outbreak of measles is that country's worst in a decade with no signs of slowing and new cases reported daily. Public health officials there say the virus is spreading faster than they can quarantine individuals. And it's not just New Zealand. England and Wales already reported more measles cases so far this year than they saw all of last year. As of mid-June, 156 cases in the United States, the highest in 15 years.

Measles can be almost entirely eliminated by universal vaccination. Vaccination rates are down, though, because some people refuse the shots on religious or philosophical grounds. Others worry that the injections themselves may be harmful, despite overwhelming evidence to the contrary.

Given the risks to public health, should we increase the cost to those who opt out? Our phone number is 800-989-8255. Email: talk@npr.org. You can also join the conversation on our website. That's at npr.org, click on TALK OF THE NATION.

David Ropeik, an author and instructor at Harvard University, wrote an op-ed for the bigthink.com entitled "Vaccines. Time for Society to Say Enough is Enough," and he joins us today from member station WBUR. Nice to have you with us today.

DAVID ROPEIK: Thanks for having me, Neil. Good to talk to you.

CONAN: And public health officials agree choosing not to vaccinate raises the risks for everybody.

ROPEIK: That's a really important point, and a lot of people who choose not to vaccinate, either themselves or their children, don't seem to realize this. In the comments that you see in the paper and in documentaries and so forth, they think it's, well, I'm not vaccinating my kid, but that's just a risk to me.

Of the 156 measles cases in the United States last year, one in five were people who were vaccinated, but the immunity had worn off or they hadn't had their booster. Or in some people, the vaccines don't work. And infants up to the age of 11 months can't be vaccinated against whooping cough and pertussis. And last year in California, there were 10 infants who basically choked to death from whooping cough because the disease spreads around when herd immunity in the community gets too low. So there is a much, much broader social implication to not vaccinating than just yourself.

And let me just add very quickly: there's a financial cost that's humongous. An analysis that was published in the journal of the American Medical Association estimates that vaccinating each cohort of children in the United States per year saves the health care system $14 billion. That's money that we all are shelling out. And the general society, in terms of lost productivity and costs for public health quarantines and whatnot, 69 billion. That's your tax money and mine.

So my argument is this. We live in a society. We are all rowing in the boat together. And I don't like big government either, quite frankly. And I'm not calling for more big government. I'm just calling for government to do what it always does. When we can't protect ourselves as individuals, government - we, writ large - does stuff to keep us safe, with drunk driving or public smoking. This is like that.

CONAN: And you point to a case in Tucson in 2008, where a woman from Switzerland who had not been vaccinated for measles visited and became symptomatic, went to a local hospital for attention and it triggered a chain of events.

ROPEIK: It's a really important point. So a lot of the fear of vaccines, for those who don't know the history, got started with a now debunked report that was out of Britain. And so the World Health Organization reports significantly declining vaccination rates in a lot of European countries. And so it may be safe here, but folks fly over here from places.

So this woman flew in from Switzerland and wasn't symptomatic, but got symptomatic with measles - which is really infectious, and the droplets stay in the air for a while - and went to the hospital. And three months later, 14 people were sick, and two local hospitals had spent $800,000 dealing with stuff. One of the health workers herself hadn't been vaccinated and made two other people in the hospital sick.

You know, one little person flying in, if our herd immunity is too low, has big social costs, and that's - again, that's the point. I don't like the idea of Big Brother telling us what to do. I'm right with the next guy, not liking being told what to do, but sometimes that's what government does.

CONAN: And so often, government says if you're going to school, you have to come with your form that shows you've been vaccinated.

ROPEIK: So one of the things that I suggested in the L.A. Times piece that I wrote this morning and the bigthink.com - and, by the way, let me hasten to say I only suggested the possible solutions to get the conversation going. I'm not a policy guy. I can't think these things through in detail, and they need to be discussed openly in a democracy. But in 21 states, you can go in to your school and say I'm not vaccinating my kid for what are called philosophical reasons. You can just say so. Now, that's a pretty low bar, so a lot of people do it.

By the way, a lot of people do it in affluent liberal communities. They're particularly concerned with modern technology and manmade risks. Seth Mnookin's wonderful book "The Panic Virus" says if you want to find communities where vaccination rates are going down, look for communities with a lot of Priuses and Whole Foods stores, an interesting phenomenon. So why not make that bar a little bit higher? In 48 states, you can opt out for religious reasons, but nobody has to prove that their religion is actually against it. Well, I'm all for the religious exemption, but it needs to be real.

So just let's raise that bar, or let's give people incentives, discounts on their health insurance with some of the money that society saves by vaccinating kids, discounts on their health insurance for vaccinating, or extra premiums if they don't, or social community activities or long school field trips that an unvaccinated kid can't go on. And so what happens when a kid is exposed to measles, he gets quarantined. It's a little bit stronger version of what we already do.

CONAN: Well, those are some of the suggestions by David Ropeik about ways we might increase the social or actual cost of declining to vaccinate yourself or your children. What do you think? Should we make this cost higher for people who opt out? 80-989-8255. Email us: talk@npr.org. And Angela's on the line, Angela with us from Modesto.

ANGELA (Caller): Hi. I'm calling because I almost killed my daughter by missing her vaccination. We were on the run from my abusive husband, and I had to take her to a county hospital for an ear infection because we were out of town and I couldn't see her regular doctor. And it turned out there was a measles outbreak. And I thought it was chickenpox, but it turned out it was measles. And she caught the measles and she nearly died. She was so weak. She couldn't even drink water from the mouth sores in her mouth.

I had to use a dropper to force her to drink water. And they had us quarantined in our apartment, and it was terrifying. She just - she was so limp in my arms she couldn't lift her head. And I don't think people realize that they're putting their children's life at risk. It's not like chickenpox. It's a dangerous disease. And there's no proof that it causes autism; that's been disproven.

And I think they arbitrarily get these weird ideas in their heads that there's reasons to not get them vaccinated but there's not. And it ups the cost to the government for the care for kids who get measles and cost of quarantining people. So, yeah, they should pay more.

CONAN: How's your daughter doing now, Angela?

ANGELA: She's 24 years old and married and healthy and (unintelligible). Thank God.

ROPEIK: Awesome. Congratulations.

CONAN: That's good news.

ANGELA: The government is the one that pulled her through. They had health workers having to come to my house and take care of us and, you know, thank God they did. But because I missed the vaccination, the government had to pay for all of that. And

ROPEIK: That's right. Angela, if I can interject, you said something interesting - excuse me, Neal, for butting in. You said that you had a personal experience with measles, and measles can be really bad. But there are other diseases that are vaccinable, where people aren't vaccinating against them, and they can literally kill kids, you know, whooping cough and meningitis. There are a whole range of them. The measles is pretty bad too. But one of the problems, as promoters of vaccines, and I'm not particularly a promoter one way or the other, say is they've been a victim of their own success. The diseases are gone.

So a lot of people haven't seen what measles can do. And they have seen in the news, unfortunately mostly, the allegations against vaccines. Let's point out by the way that vaccines do have risks. There are side effects. There are allergic reactions, but those are much lower than the diseases they protect against - much, much. But you've seen measles.

A lot of people haven't seen the measles. And one of the things that I wrote my piece about is before we start seeing all the bodies and have to react to the bodies, let's think this through before we then have the evidence and then kind of backlash against the fear of vaccines. Let's be thoughtful about it upfront.

ANGELA: Yeah. I was completely ignorant of what measles could do.

CONAN: Thanks, Angela. We're glad you...

ANGELA: They were terrifying.

CONAN: Glad it all worked out.

ANGELA: Thank you.

CONAN: Let's see. We go next to - wrong button - Dan. Dan's with us from Albion in Iowa.

DAN (Caller): Hi.

CONAN: Hi. You're on the air. Go ahead please.

DAN: Well, I wanted to make a comment concerning the shots themselves. And, you know, I understand the business about no autism. But when our son was about 14 months old and was scheduled for his next round of vaccinations, he had his MMR: measles, mumps and rubella shot. And within two days, he exhibited incredible changes in his behavior, neurological changes, and it's not just a crazy reaction on our part.

But we saw him becoming autistic to the point where he'd watch the old "Teletubbies" program and scream when the baby's face in the sun would appear. He stopped walking. He stopped doing a lot of things. We had many pediatricians that we took him to, who insisted that a part of his problem was his gut had been trashed by the MMR as a combo. Now, we wouldn't mind paying for individual shots if that would be the case. But when you see such a dramatic change in a child after receiving a shot, you don't want to go back and do that again. We would gladly get him vaccinated for measles if we could get a measles shot separate from the other two.

ROPEIK: Dan, let me ask Neal's question. How's your son now?

DAN: He is great.

ROPEIK: Terrific.

DAN: It's a lot of work.

ROPEIK: Wow.

DAN: We did what we had to do to take him off of - it was proteins, all kinds of proteins that his intestines didn't seem to be able to handle.

ROPEIK: Great. I know...

DAN: He was fine with all the foods until that point. And suddenly, he could no longer tolerate any dairy products or any gluten. And - but he is now 13. He's a little small for his size, but he is a well-adapted child. He's very athletic...

ROPEIK: Nice. Nice. Terrific.

DAN: ...very smart. And we're doing great without the extra shots. We've had him immunized for other things, but we just refused to give him the MMR combo.

ROPEIK: I only - I can't comment on your specific case, of course, and don't dare to. And I totally empathize with how awful it is. And I have friends who have autistic kids and kids with all sorts of hard, difficult things. And I'm grateful to have healthy kids. Without getting into the science, though, I will say that the fear that you're talking about has been researched as carefully and thoroughly as pretty much any risk to kids has been in the last long, long, long, long time.

And the body of evidence - and you can never say never, never ever - but the body of evidence on that one is so overwhelmingly powerful that it's now to the point where society has to make a choice - and I don't know what the right one is, I'm just calling the choice here by this conversation - about whether that risk is, A, real and, B, big enough to outweigh the risk that Angela was just talking about and all the kids or the parents who've lost kids to death, choking to death from whooping cough. There's a tradeoff here. Vaccines do have risks.

I don't think they have the autism risk as I read the evidence, but that's up to you. There's a tradeoff society has to realize. And so far, we've only paid attention to the vaccine's scary side. And we have to remember that diseases aren't gone. And that's a big side, too, and it's coming back.

DAN: No, I agree with you 100 percent. And, you know, I understand the research. But if I stood out in a middle of a field and got struck by lightning, do you think I'd ever do that again?

(SOUNDBITE OF LAUGHTER)

ROPEIK: If you're lucky enough to stand around.

CONAN: Well, thanks very much for the...

ROPEIK: I get it. I get it. I get it.

DAN: ...doesn't go out there, you know? And I'm just not going to put my son through that again.

CONAN: I understand that, Dan.

DAN: Not going to have it happen. And like I said, my big issue is we had dealt with many pediatricians.

CONAN: I...

DAN: ...and many of them said it was the grouping of those three shots together that...

CONAN: Why can't they be unbundled and so therefore...

DAN: Right.

CONAN: Right.

DAN: And at his age, he's more than willing to get three shots in order to not have to possibly face, you know, some kind of serious complication again.

CONAN: Dan, thanks very much for the call. We appreciate it. We're talking about the price of vaccines and the price of not having vaccines. You're listening to TALK OF THE NATION from NPR News. And let's go next to Robert. Robert with us from Cape Coral in Florida.

ROBERT (Caller): Hello there. I just wanted to mention that the CDC has data showing that in 1900, out of every 100,000 Americans, 14 died from measles. That gradually came down to under one for every 100,000 in 1940. But measles vaccine wasn't introduced until 1963. And ever since 1940s, it's been under one. Plus, I'm a physician and I want - my blood boils when I hear about the theory of herd immunity. It is such a junk science myth that you being vaccinated will protect me from a disease that someone else has. It's absolute nonsense. The immune system does not work that way.

And if you want - and I think when we're listening to data from government agencies like the FDA and the CDC, we have to remember that the employees of the FDA and the CDC, every single one of them from the bottom to the top, can have jobs with and stock in drug companies who are selling these very vaccines...

CONAN: Robert, Robert...

ROBERT: Yes?

CONAN: ...you just cited CDC data in support of your argument, and now you're questioning all CDC data?

ROBERT: I'm not questioning CDC data, but according to...

CONAN: You're not questioning CDC data that agrees with you, but let's get...

ROBERT: No, no. No, no, no, no, no, please. The data is one thing. The actual facts and figures is one thing, but then what their recommendations are is not coherent...

CONAN: Well, let's have - we don't have a - yeah.

ROBERT: ...with actual data.

CONAN: We have very little time.

ROPEIK: Here's one interesting thing with the CDC and measles. In 2008, the CDC declared measles eradicated. That's not promoting vaccination. That's declaring the disease as eradicated. And they have subsequently had to put out a nationwide health emergency notice that the disease is coming back. So you've seen that agency on both sides of this exact issue. I don't share your mistrust in that agency.

CONAN: David Ropeik, thanks very much for your time today. We appreciate it.

ROPEIK: Thanks for having me.

CONAN: David Ropeik, with us from member station WBUR Boston, an instructor at Harvard where he wrote an op-ed for the bigthink.com entitled "Vaccines. Time For Society to Say Enough is Enough." He's also the author of the book "How Risky Is It, Really?: Why Our Fears Always Don't Match the Facts." Tomorrow, the bloom of protests across the Middle East became known as the Arab Spring, now many countries struggle with what comes next. We'll talk about what happens after the Arab Spring. Join us for that. I'm Neal Conan. It's the TALK OF THE NATION from NPR News. Transcript provided by NPR, Copyright National Public Radio.